Obamacare Repeal Fails Again: What’s Next for Health Care?

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"Game of Thrones" fans know that what is dead may never die. The saying may hold true for Obamacare repeal as well.

The collapse of the Senate’s latest health care bill means that Republicans will miss the deadline for repealing the Affordable Care Act this year using a process that would require only 50 votes. The budget rules that enable that process expire on September 30, the end of fiscal year 2017.

Senate Republicans had to decide Tuesday whether to bother with a vote on the doomed bill. Was it better to try to show the conservative grassroots that they tried or to avoid the spectacle of failure on the Senate floor? They opted to pull the bill. But Republicans aren’t giving up entirely on the goal of Obamacare repeal. “We haven’t given up on changing the American health care system,” Senate Majority Leader Mitch McConnell (R-KY) said. “We are not going to be able to do that this week, but it still lies ahead of us, and we haven’t given up on that.”

Here’s where the health care debate goes next:

The Final Margin Still Matters: Even without a vote, the margin of defeat matters for the future, writes David Leonhardt of The New York Times. “The more senators who oppose Graham-Cassidy, the less likely that yet another version of Trumpcare will emerge. … If Republicans come to terms with their total lack of a reasonable repeal plan, more of them will be open to a bipartisan compromise to fix Obamacare’s flaws.” Sen. Lisa Murkowski (R-AK) issued a statement Tuesday decrying the “lousy process” for the Graham-Cassidy bill, but she did not indicate how she would have voted.

Another Repeal Attempt Could Happen: Senate Majority Leader Mitch McConnell said Republicans are moving on to tax reform, but some GOP lawmakers reportedly hope to start over by having health care included in the budget blueprint for 2018 — the same blueprint that’s supposed to include instructions for tax reform so that it can pass with a simple GOP majority. Squeezing in health care could threaten the chances that a budget vehicle passes, potentially torpedoing tax reform in the process, and prominent lawmakers in both the House and Senate have already come out against the idea. Still, Graham predicted that his bill could return. “There are 50 votes for the substance,” he said. “There are not 50 votes for the process.” Even if Obamacare repeal is left out of the 2018 budget, Congress could still come back to it soon: One option is to use the fiscal 2019 budget. “It’s not a question of if, but when,” Graham said.

A Bipartisan Fix Seems Unlikely Right Now: About 70 percent of Americans want Congress to work on stabilizing the ACA marketplaces. Senate Minority Leader Chuck Schumer (D-NY) said again Monday that once Obamacare repeal is off the table, Democrats are willing to work with Republicans on that. And Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) had made some progress on a plan to guarantee federal subsidies for low-income Americans in exchange for additional flexibility for states on how that money could be spent. But the bipartisan effort stopped when the last-ditch Obamacare repeal appeared to be gaining momentum, and it now looks stalled. "We stopped the bipartisan talks last week because my goal wasn't just to get a bipartisan agreement — it was to get a bipartisan result,” Alexander said Monday. “I didn't see any way to get one in the current political environment." On Tuesday, he said he would consult with Murray to try to find consensus on steps that would help in 2018 and 2019. But other Republican leaders “indicated they have little interest in shoring up the existing insurance market,” The Washington Post reported Tuesday. “Instead, they suggested, the ongoing instability would backfire on Democrats and build momentum for the ACA’s eventual repeal.”

So the 2018 Insurance Market Will See Steep Rate Hikes: Insurers have until Wednesday to finalize contracts with the federal government to sell health plans through the Obamacare marketplace next year. Premiums are set to climb by double digits in many places, and insurers have placed at least part of the blame on the ongoing uncertainty about whether the Trump administration will continue to make cost-sharing reduction payments. The Trump administration has made the payments so far, but has not committed to continuing them. Any Obamacare stabilization efforts at this point are far more likely to affect 2019 rates. A safe bet for the next year: We’ll hear a lot more criticism of the health care law from Republicans, lots of complaints from Obamacare supporters about the administration’s sabotaging the exchanges, and plenty of complaints from Americans about rising health care costs.

As editor in chief, Yuval Rosenberg oversees all aspects of The Fiscal Times' website and email newsletter. His writing has appeared in publications including BusinessWeek, CNBC.com, CNNMoney.com, Fast Company, Fortune, Newsweek, Money and Time.